Official Vows Crackdown on County Doctors : Inquiry: Firings are pledged after Board of Supervisors attacks handling of moonlighting charges.

Chastened by sharp attacks from an angry Los Angeles County Board of Supervisors, a top Department of Health Services official pledged Tuesday to root out and fire county doctors who moonlight too much, and to put in place strengthened controls to prevent fraud and waste of taxpayer money.

Supervisor Yvonne Brathwaite Burke criticized the health department for failing to crack down on the problem sooner, saying that past inattention now makes the county look especially bad, at a time when it is laying off thousands of health workers because of an unprecedented financial crisis.

“I’ve had complaints about this again and again and again, and every time I get a report back saying, ‘We’re working on it,’ ” said Burke, who since 1992 has represented the district that includes Martin Luther King Jr./Drew Medical Center, one of six county hospitals under investigation over moonlighting doctors. “Now maybe this will do it. Maybe once the L.A. Times starts writing about something, we’ll get some reaction on this, because some of the doctors in our hospitals not putting in a full day causes us a lot of concern.”

The Times reported Sunday that county investigators are looking into allegations that some county doctors are taking advantage of lax oversight to violate regulations on outside employment.

After Tuesday’s board meeting, Mary Jung, chief deputy director of the health department, promised an aggressive probe into the accusations and the department’s own procedures and policies.

“We want to do an extremely thorough review of these allegations,” Jung said. “If there are doctors abusing their privileges, we want to make sure they are fired.”

In addition to concerns over moonlighting, internal health department records indicate that county officials have been concerned in recent years about another potential area of abuse: overtime.

According to one investigative report, a doctor suspected of attendance problems accumulated 146 hours of overtime between April and June, 1994--a period in which he took off significant periods of time but put in for overtime when he came to work after hours.

Investigators suspected that the doctor, whose name was excised from one document obtained by The Times, may have received even more overtime during the period. But when they sought other time cards to review, they were told by hospital payroll employees that the cards were “missing.” The investigators noted, however, that the doctor’s personnel file “disclosed no negative notations or remarks relative to his work habits and or attendance.”

Sources said they believe other doctors suspected of moonlighting also may be putting in for excessive amounts of overtime.

Although supervisors Tuesday took no specific action regarding moonlighting doctors, Burke informally asked the health department to start checking county doctors’ hours and compare them to the times they say they spend at other hospitals and at private practices. Supervisor Zev Yaroslavsky also requested more active investigations and greater oversight of county doctors.

“It’s got to go beyond your department,” Yaroslavsky told Jung, suggesting that the district attorney’s office investigate some doctors for criminal fraud violations. “There must be a law against taking [taxpayer] money and not doing your job.”

Jung is the de facto director of the health department until a successor is chosen for outgoing Health Services Director Robert C. Gates. Gates, who is retiring Nov. 1, has frequently missed board meetings in recent months, at times citing poor health.

After the meeting, Jung said she plans to take other actions, including updating all the conflict-of-interest statements required of doctors. In the past, investigators have concluded, some time cards have been spotty and vague, when doctors and their supervisors filled them out at all.

Jung also said regional hospital administrators were “chewed out” during a conference call Monday and ordered to watch doctors more closely and not sign time cards if there is any suspicion of improper moonlighting.

The health official told the supervisors that most doctors are not engaged in excessive moonlighting, but that “there are always a few rotten apples” in a large department, later adding that she believes doctors who want to cheat the county will do so no matter what.

But, she added, it has been virtually impossible to build a case against some doctors because of “collusion,” in which supervisors either knowingly ignored excessive moonlighting or simply approved time cards without checking.

Documents and interviews indicate that calls for stronger controls date back to at least 1991, including adoption of up-to-the-minute faculty call schedules that accurately reflect the whereabouts of physicians at all times, unannounced rounds by supervisors to check on doctors and even time clocks for doctors.

Yet department records and interviews with health officials indicate that most medical departments at the county’s hospitals don’t even have rudimentary controls, such as sign-in sheets.

“They need to be strengthened,” Jung said, adding that she would try to ascertain the status of such safeguards. Top health officials, she said, “have reminded the hospitals over and over and over again to be mindful of time abuse. They say they have implemented procedures [and] in some cases they have.”

When sign-in sheets were established in the emergency room at King two years ago, doctors were incensed and hired a lawyer, who got the county to back down. Although the policy was later reinstated, doctors ignored it despite repeated warnings, according to health department reports.

Jung said that getting doctors to cooperate will be hard, since their exempt status allows them much leeway in establishing their schedules. “There’s all kinds of reasons as to why the doctors are resisting,” she said.